When we undertake a keto diet consisting of high fat and approximately 30 grams of net carbs per day, our livers produce ketone bodies. Tecton contains 10 grams of ketones identical to these.
Scientific studies have shown that ketones, whether produced in the body during prolonged fasting (endogenous ketones) or taken as a dietary supplement (exogenous ketones), can improve brain function.
They can also help protect the brain from harm, whether that harm arises from an injury (such as a concussion) or a disease. This is termed a “neuroprotective effect.” In this article, we provide some of the evidence that supports the use of ketones to improve brain function. While endogenous ketones can be helpful in this regard, it can be very difficult to maintain prolonged fasting and/or a strict low-carbohydrate diet required for your body to produce endogenous ketones. Exogenous ketones on the other hand, can have similar beneficial effects and can be consumed as a dietary supplement. In fact, exogenous ketones can prove very helpful in certain conditions and are viewed as a promising therapeutic strategy to meet the needs of the brain during an energy crisis (Poff et al., 2021). They can also be used as a nutritional tool to provide a quick energy boost and allow for the elongation of a fasting period. When consuming dietary ketones, the use of ketone esters results in a much more rapid and robust elevation in blood ketone levels as compared to ketone salts (Stubbs et al., 2017). Moreover, because sticking to a ketogenic diet may be difficult for many people, the use of exogenous ketones may be more practical—as highlighted in a recent systematic review on the topic (Dewsbury et al., 2021).
The human brain is a highly complex and amazing organ, controlling all aspects of our lives including breathing, thoughts, memory, decision making, and movement. Those who suffer with any form of brain dysfunction know how devastating this can be. This reality and the quest for a return to normal brain function has prompted continued investigation into treatment options for those with such impairments.
Treatments include both pharmacologic and lifestyle approaches. Related to the latter, most individuals accept the well-documented fact that structured exercise can enhance cognitive performance, as can the intake of a nutrient dense diet—with efficacy noted for a variety of different dietary protocols.
In addition, select dietary supplements have been shown to help with aspects of brain health—with recent emphasis placed on “nootropics” or those supplements touted to improve cognition, memory, concentration, and related variables.
One target ingredient that continues to receive attention is ketones (Kovacs et al., 2021). These functional groups serve as a unique energy source, capable of crossing the blood-brain barrier, typically produced in the liver from fatty acids (what is referred to as endogenous ketone production) but also available as a dietary supplement (what is referred to as exogenous ketones).
This article will discuss the importance of brain health, while sharing information specific to ketones and how this unique energy source may prove helpful in situations when the brain is compromised.
An Overview of Brain Health
The brain and spinal cord make up the central nervous system and are often referred to as the body’s control center or “central command.” The brain is responsible for maintaining life and all aspects of function. This includes but is not limited to memory, focus, concentration, reaction time, and balance—variables that are of great importance to overall cognitive and physical performance.
If the goal is to improve the above, there are many lifestyle factors that should be considered. These include structured exercise and physical activity; maintenance of a healthy weight, blood pressure, and blood glucose; adequate nightly sleep; remaining cognitively engaged (e.g., continuing to learn and be challenged mentally); smoking cessation, and consumption of alcohol in moderation (or not at all). These items should be thought of as the “first-line” defense in supporting optimal brain health. Beyond these, you might consider select dietary supplements, with exogenous ketones being one which is well-supported by the scientific literature.
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An Overview of Ketones and their Delivery to the Brain
Our bodies were designed with the magnificent ability to create ketones in times of need. Simply put, ketones are an alternative energy source produced and/or used by the body when glucose (carbohydrate) stores are low. The “ketogenic diet” or “keto” has gained much popularity in recent years for those seeking weight/fat loss. This is because when carbohydrate is severely restricted (usually to less than 30 grams/day; the equivalent of one piece of fruit or one slice of bread), blood glucose and insulin levels remain low.
Stored fats are then broken down and the fatty acids are released into the bloodstream and transported to the liver to be converted into ketones. This breakdown of stored fat should theoretically lead to an overall loss in body fat/weight, which is the goal of many. Once produced, the ketones can be released from the liver and travel in the bloodstream to various tissues to be used as a fuel source. One such tissue is the brain, which can readily use ketones, as they are able to cross the blood-brain barrier. And if carbohydrate sources are very low, ketones are the prime option to fuel the energy-hungry brain. Note: lactate can also be used as an energy source; and the liver can convert glycerol and certain amino acids into energy, through a process known as gluconeogenesis.
While ketone production is revved up during periods of severe carbohydrate restriction or fasting, usually for a period of at least 48 hours, some ketone production is observed after shorter periods of similar dietary manipulation. For example, those adhering to an intermittent fasting regimen using a standard 8 hours on:16 hour off cycle will likely experience some level of additional ketone production during the 16-hour fasting period. Blood ketone levels should be further elevated with the use of exogenous ketones, which may provide additional energy. This may also prove important in allowing for an extension of the fasting period, which may in turn further produce endogenous ketones and result in greater fat loss over time. In this way, ketone supplements can serve as a “nutritional tool” to help elongate a fast, possibly leading to greater benefits from nutrient restriction.
How Ketones can Impact the Brain
Although many people adopt a ketogenic diet for purposes of weight/fat loss and improved aesthetics, a more important finding relates to the role of ketones to aid various aspects of brain health.
Neurodegenerative diseases are often characterized by a deterioration of the brain’s glucose metabolism. Hence, providing an alternative fuel source such as ketones may prove helpful (Jensen et al., 2020).
There are multiple anecdotal reports specific to healthy individuals adhering to a ketogenic diet and/or using exogenous ketone supplements to improve focus, concentration, and attention. While this is interesting, what excites research scientists and clinicians more are the studies noting an improvement in certain clinical conditions as a result of either following a ketogenic diet or supplementing with exogenous ketones. Ketone-induced neuroprotection can improve overall brain health, may delay age-related disease via improving mitochondrial function, can provide antioxidant and anti-inflammatory effects, and can provide modulation of neurotransmitter systems (Kovacs et al., 2021). A few clinical conditions in which ketones have been shown to be beneficial are presented below, with an initial focus on ketone use by the relatively healthy brain.
Ketones and Concussion
Concussion is a form of traumatic brain injury (TBI) and represents a significant health crisis. In most individuals, symptoms resolve within one month but those with post-concussion syndrome (PCS) may continue to experience symptoms for many months or years, with few treatment options available.
Thankfully, more attention is now being placed on ketones as a therapeutic tool in treating TBI (Daines et al., 2021). Since concussions are not planned and typically cannot be predicted (perhaps outside the context of combat sports), prophylactically adhering to a ketogenic diet for purposes of elevating blood ketone levels is unlikely. In this case, exogenous ketones may prove valuable in the treatment of acute concussion, as they can address the cerebral energy deficit, while also serving to reduce oxidative damage and inflammation acutely. Animal studies of TBI/concussion models using the ketogenic diet have noted improved structural and functional outcomes (Prins and Matsumoto, 2014). Initial study using the ketogenic diet in humans has been met with favorable findings, although more work is needed (Rippee et al., 2020). The clinical data support the use of exogenous ketones to improve recovery in those suffering TBI, making ketones an attractive alternative fuel source that can provide the brain with energy to function optimally and recover fully.
Ketones and Cognition
Aside from the clinical conditions presented below, individuals with mild cognitive impairment (MCI) or those who may be otherwise healthy but who seek superior cognitive performance may also benefit from ketones.
It has been reported that both a ketone-inducing beverage (Fortier et al, 2021) and a very low carbohydrate ketogenic diet (Krikorian et al., 2010) can result in an improvement in cognition for those with MCI. A recent human study noted improved cognition and increased cerebral blood flow following 14 days of exogenous ketone supplementation in middle-aged obese adults (Walsh et al., 2021). Ketone supplementation has also been reported to attenuate the decrement in cognition observed in young men completing a simulated soccer match (Quinones and Lemon, 2022). Beyond human subjects, animal data support the relationship between elevated ketones and improved working memory (Hernandez et al., 2018), as well as greater cognitive performance and a lower probability of experiencing mental fatigue (Niepoetter et al., 2021).
Ketones and Alzheimer’s Disease
In the United States, as many as 6.5 million individuals age 65 and older live with Alzheimer’s Disease, with a significant number of annual fatalities (sixth leading cause of death in the country).
While multiple treatment options for Alzheimer’s have been investigated, the ketogenic diet or supplementation with exogenous ketones has received a great deal of attention in recent years. While this method is not uniform in recommendation, it certainly has promise for improving overall function in those with Alzheimer’s (Lilamand et al., 2020).
Because neurodegenerative diseases such as Alzheimer’s are associated with a defect in brain glucose metabolism, ketones can supply vital energy to brain cells that may be deprived of fuel. The presence of ketones may enhance mitochondrial function (the energy producing component of the cell) and has been reported to have a neuroprotective effect on aging brain cells (Rusek et al., 2019). Ketones may also reduce the expression of inflammatory mediators that are thought to be associated with cognitive decline. As concluded in a recent review on the topic (Grammatikopoulou et al., 2020), “Although research on the subject is still in the early stages and highly heterogeneous in terms of study design, interventions, and outcome measures, ketogenic therapy appears promising in improving both acute and long-term cognition among patients with Alzheimer’s Disease/Mild Cognitive Impairment.”